Unilateral Clear Thin Rhinorrhea: How Often Is It a Cerebrospinal Fluid Leak?
Recommended Citation
Mason W, Mackie H, Kulawczyk A, Jin J, and Craig JR. Unilateral Clear Thin Rhinorrhea: How Often Is It a Cerebrospinal Fluid Leak? Ann Otol Rhinol Laryngol 2025.
Document Type
Article
Publication Date
5-15-2025
Publication Title
The Annals of otology, rhinology, and laryngology
Abstract
OBJECTIVES: Determine frequencies of conditions causing unilateral clear thin rhinorrhea (UCTR), and assess whether certain clinical features are associated with CSF rhinorrhea.
METHODS: This was a retrospective review identifying all patients presenting with UCTR to one rhinologist over a 6-year period. The conditions causing UCTR were recorded, and the following demographic or clinical variables were collected when available: body-mass index (BMI, kg/m2), gender, age, race, and self-reported drainage volume (whether the UCTR dripped out the nose and could be collected, or it felt like a wet nostril with intermittent running down lip that was unlikely to be collectable).
RESULTS: Of 3,041 patients, 146 were identified with at least UCTR (4.8%). Mean age was 56.2 ± 17.6 years, and 65.8% were female. Amongst UCTR, nonallergic rhinitis (NAR) was the most common cause (45%), followed by CSF rhinorrhea (30%). On multivariate analysis, the following were significantly positively associated with CSF rhinorrhea: BMI≥30 (OR=4.95), ages 45-54 years (OR=3.67) and 55-64 years (OR=4.15), and self-reported UCTR dripping with collectability (OR=5.96)).
CONCLUSIONS: NAR was the most common cause of UCTR, representing nearly 50% of cases. However, CSF rhinorrhea still represented 30% of cases, reinforcing that UCTR should be worked up for CSF rhinorrhea, ideally with B2-Tf testing. BMI ≥30, ages 45-64 years, and patient-reported higher volume UCTR were positively associated with CSF rhinorrhea. If B2-Tf testing is negative or unobtainable, or clinical suspicion for CSF leak is low, clinicians can consider starting medical therapy for rhinitis or rhinosinusitis before pursuing further invasive CSF confirmatory testing.
PubMed ID
40370059
ePublication
ePub ahead of print
First Page
34894251338895
Last Page
34894251338895
